Earlier this year the Centers for Disease Control (CDC) responded to the growing opioid addiction epidemic in the U.S. by issuing new recommendations for health care providers who prescribe the painkillers for chronic pain.
The guidelines were published recently in the Journal of the American Medical Association (JAMA).
The advice is intended for primary care doctors, who prescribe nearly half of all opioid painkillers prescribed in the U.S. The guidelines are not intended for physicians treating cancer patients or for end-of-life care.
Some pain specialists and patient advocates were angered when a draft was released in the fall. Opponents cited a lack of evidence supporting many of the guidelines, and feared patients who truly need strong painkillers wouldn’t be able to access them.
The American Academy of Family Physicians, for instance, believes the CDC’s recommendation that opioids should not be the first treatment used for people with chronic pain is too strong a stance, considering how weak the evidence is.
But the guidelines are not binding, and doctors can’t be punished for not adhering to them.
However at the state level, prescribing rules have become more strict. For example last month, New York joined a number of other states that will stop using paper scripts. Under a new state law, physicians will be required to transmit all prescriptions for patients online and directly to pharmacies. Doctors who break this law face harsh penalties, including fines and prison time.
For CDC director Tom Frieden, the guidelines signify “a culture shift for patients and doctors.” He said in an interview with The Washington Post:
“We are waking up as a society to the fact that these are dangerous drugs. Starting a patient on opiates is a momentous decision, and it should only be done if the patient and the doctor have a full understanding of the substantial risks involved.”
Frieden authored an editorial which appeared recently in The New England Journal of Medicine in which he argued more long-term research is needed to understand how useful opioids truly are, as most placebo-controlled randomized trials usually only have a span of 6 weeks or less.
“Whereas the benefits of opioids for chronic pain remain uncertain, the risks of addiction and overdose are clear. Although abuse-deterrent formulations may reduce the likelihood that patients will inject melted pills, these formulations are no less addictive and do not prevent opioid abuse or fatal overdose through oral intake.”
The Food and Drug Administration (FDA) is also taking a closer look at its policies on opioid medications, and the Senate recently passed legislation aimed at expanding drug abuse treatment and prevention, though it lacks the funding to be effective.
The Drug Enforcement Administration (DEA) is taking the opioid epidemic seriously, and is pushing doctors to prescribe the powerful painkillers more responsibly. The departments for Veterans Affairs and Defense already have opioid policies in place for their patients.
Said Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, a nonprofit that has been urging a curb on the use of opiates:
“For the first time, the federal government is communicating clearly that the widespread practice of prescribing opioids for chronic pain is inappropriate, that the risks outweigh the benefits.”
Kolodny called the new CDC guidelines “a game changer.”